Are iodinated contrast agents detrimental in acute cerebral ischemia? An experimental study in rats.

Doerfler, Arnd; Engelhorn, Tobias; Kummer, Ruediger von; Weber, J. E.; Knauth, Michael; Heiland, Sabine; K, Sartor; Forsting, Michael

doi:10.1148/radiology.206.1.9423675

Cited by 54 publications

(21 citation statements)

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“…The intravenous administration of nonionic iodinated contrast material involved is easily performed, even in acute stroke patients. 45 The radiation dose in a perfusion CT study is equivalent to that in a standard cerebral CT examination. For the acquisition of four adjacent 10mm sections at 80kVp, the measured normalized and weighted CT dose index (nCTDIw) amounts to 0.112mGy/mAs.…”

Section: Discussionmentioning

confidence: 99%

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Wintermark¹,

Reichhart²,

Thiran

et al. 2002

Annals of Neurology

460

283

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The purpose of this study was to determine the prognostic accuracy of perfusion computed tomography (CT), performed at the time of emergency room admission, in acute stroke patients. Accuracy was determined by comparison of perfusion CT with delayed magnetic resonance (MR) and by monitoring the evolution of each patient's clinical condition. Twentytwo acute stroke patients underwent perfusion CT covering four contiguous 10mm slices on admission, as well as delayed MR, performed after a median interval of 3 days after emergency room admission. Eight were treated with thrombolytic agents. Infarct size on the admission perfusion CT was compared with that on the delayed diffusion-weighted (DWI)-MR, chosen as the gold standard. Delayed magnetic resonance angiography and perfusion-weighted MR were used to detect recanalization. A potential recuperation ratio, defined as PRR ‫؍‬ penumbra size/(penumbra size ؉ infarct size) on the admission perfusion CT, was compared with the evolution in each patient's clinical condition, defined by the National Institutes of Health Stroke Scale (NIHSS). In the 8 cases with arterial recanalization, the size of the cerebral infarct on the delayed DWI-MR was larger than or equal to that of the infarct on the admission perfusion CT, but smaller than or equal to that of the ischemic lesion on the admission perfusion CT; and the observed improvement in the NIHSS correlated with the PRR (correlation coefficient ‫؍‬ 0.833). In the 14 cases with persistent arterial occlusion, infarct size on the delayed DWI-MR correlated with ischemic lesion size on the admission perfusion CT (r ‫؍‬ 0.958). In all 22 patients, the admission NIHSS correlated with the size of the ischemic area on the admission perfusion CT (r ‫؍‬ 0.627). Based on these findings, we conclude that perfusion CT allows the accurate prediction of the final infarct size and the evaluation of clinical prognosis for acute stroke patients at the time of emergency evaluation. It may also provide information about the extent of the penumbra. Perfusion CT could therefore be a valuable tool in the early management of acute stroke patients.

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Section: Discussionmentioning

confidence: 99%

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Wintermark¹,

Reichhart²,

Thiran

et al. 2002

Annals of Neurology

460

283

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“…Ionic hyperosmolar IRCM (ϳ1200 mOsm) has been abandoned for IA use due to increased neurotoxicity compared with the lowosmolar IRCM (ϳ700 mOsm). Doerfler et al 18 showed decreased infarct volume following IV nonionic low-osmolar IRCM (770 mOsm) versus ionic hyperosmolar iothalamate (2520 mOsm) in a rodent permanent occlusion stroke model, and they suggested that osmolarity, at least in part, explained the effect. Newer iso-osmolar IRCM is theoretically less cytotoxic due to lower osmolarity (similar to plasma, ϳ300 mOsm), compared with low-osmolar IRCM.…”

Section: Discussionmentioning

confidence: 99%

Decreased Infarct Volume and Intracranial Hemorrhage Associated with Intra-Arterial Nonionic Iso-Osmolar Contrast Material in an MCA Occlusion/Reperfusion Model

Morales

Kurosawa

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Infarct volume and intracranial hemorrhage after reperfusion with nonionic low-osmolar and isoosmolar iodinated IRCM has not been previously compared. We postulated that iso-osmolar and low-osmolar iodinated contrast media exert varied effects on cerebral infarct after intra-arterial injection. We compared infarct volume and hemorrhagic changes following intra-arterial infusion of iodixanol, iopamidol, or normal saline in a rat MCA occlusion/reperfusion model.

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“…For example, contrast agents, especially the ionic type, are known to cross the blood-brain barrier in acute ischemia and might have a toxic effect on ischemic brain tissue. [23][24][25][26] In addition, IA contrast injections in acute ischemic stroke patients may increase the risk of intracerebral hemorrhage. 27 Similar rates of parenchymal hematomas between the CTA and control groups in our study, however, do not suggest a substantial effect on postthrombolysis hemorrhagic transformation.…”

Section: Discussionmentioning

confidence: 99%

Does the Application of X-Ray Contrast Agents Impair the Clinical Effect of Intravenous Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients?

Dzialowski

Puetz²,

Buchan³

et al. 2012

Stroke

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Background and Purpose-Experimental data suggest a negative interaction between x-ray contrast agents and fibrinolytic efficacy of recombinant tissue-type plasminogen activator (rtPA). We hypothesized that the application of a contrast agent before intravenous thrombolysis with rtPA reduces its clinical efficacy in acute ischemic stroke. Methods-We retrospectively studied consecutive ischemic stroke patients receiving contrast agents for computed tomography angiography before intravenous treatment with rtPA. We compared functional outcomes with an historical control group from the Canadian Alteplase for Stroke Effectiveness Study who did not receive contrast agents before thrombolysis with rtPA. Primary end point was favorable functional outcome at 90 days defined as modified Rankin Scale scores 0 to 2. We performed logistic regression analysis and a propensity score matching analysis to estimate the effect size of contrast agent use as a negative predictor of outcome. Results-We identified 111 patients for the computed tomography angiography and 1119 patients for the control group.Proportions of favorable functional outcome were 47.7% (53/111 patients) for the computed tomography angiography group and 49.5% (542/1094 patients) for the control group (Pϭ0.77). Adjusted probabilities for favorable outcome were 0.48 (95% CI, 0.37-0.58) and 0.51 (95% CI, 0.47-0.54), respectively. Contrast use was associated with reduced odds of favorable outcome (OR, 0.62 ; 95% CI, 0.38 -0.99). Propensity score matching suggested a larger effect size (OR, 10.0%; 95% CI, 0.5%-19.3%). Conclusions-Our study did not show a significant negative clinical effect of x-ray contrast agents applied before intravenous thrombolysis with rtPA. However, to confirm a possible small negative interaction between contrast agents and rtPA, additional experimental and prospective clinical studies are needed. (Stroke. 2012;43:1567-1571.)

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Are iodinated contrast agents detrimental in acute cerebral ischemia? An experimental study in rats.

Abstract: Bolus injection of the nonionic iopromide does not statistically significantly affect infarction volume or cerebral ischemia symptoms. Nonionic rather than ionic contrast agents should be preferred during acute cerebral ischemia.

Cited by 54 publications

References 0 publications

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Prognostic accuracy of cerebral blood flow measurement by perfusion computed tomography, at the time of emergency room admission, in acute stroke patients

Decreased Infarct Volume and Intracranial Hemorrhage Associated with Intra-Arterial Nonionic Iso-Osmolar Contrast Material in an MCA Occlusion/Reperfusion Model

Does the Application of X-Ray Contrast Agents Impair the Clinical Effect of Intravenous Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients?

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